#Covid Crisis: Can Efficiency Kill?

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Ever since I have entered the corporate world, the one word that is most used in defining the Key Performance Indicators (KPIs), system designs, process engineering, product definitions, marketing campaigns, departmental achievements, manufacturing processes, capacity planning, corporate targets and almost every aspect of economic activity is Efficiency.

It has been playing both the role of a key driver and ultimate target for defining progress and measure of success for individuals and enterprises alike.

The classical definition for efficiency is –

(of a system or machine) achieving maximum productivity with minimum wasted effort or expense.’

‘(of a person) working in a well-organized and competent way.’

Many companies project it as their competitive advantage and even make significant effort in communicating the same to their customers. To the extent that there are companies that have made efficient means of making this communication as their core business.

Efficiency is good to achieve as it brings us to a point of deriving maximum impact with minimal (or shall we say optimal) expense of resource.

Consequently, we have many operational and business best practices, to name a few –

  • Just-In-Time Manufacturing
  • Lean Principles
  • Business Process Management with Six Sigma
  • Optimal capacity building and utilization

Its good business and makes a lot of sense.

The privately managed healthcare ecosystem is no exception to this drive for achieving greater efficiency. Many of these institutes have revenue and profit targets. Consequently, we have seen care providers such as hospitals and clinics running highly efficient systems with forecasting models for bed utilization, testing facilities design, resource planning of doctors, nurses and other care providers. Similarly, we see pharmaceutical companies running highly efficient mechanisms to build the next successful cure or vaccine. These have helped to derive significant profitability for these entities.

The state-managed healthcare ecosystem, on the contrary, has similar aspirations but is way behind in the journey. Currently, it pedals on adversely affecting inefficiencies.

But what happens when a highly efficient and extremely effective opponent attacks an efficient ecosystem?

The Covid-19 mutant B1.617 has demonstrated a significantly high level of efficiency. It is contracting the humans it is contacting. It deploys itself silently in the sinus region before making its way to respiratory tract of the affected humans. It is doing this without fail, at a large scale. It is efficient, precise and non-compromising in its attack. One lowers the guard of the behavorial protocol and chances of getting infected increase multi-fold.

The spread has wreaked havoc and the healthcare ecosystem has been put to an unprecedented test. Shortage of beds, medicines, and even oxygen derailed the whole care process, putting it under tremendous stress. Insufficient care led to many people either being permanently affected and in more acute cases losing their lives.

The situation demands a review of some of the driving factors of designing of this ecosystem.

  1. Has the lack of sufficient redundancy in hospitals forced us into economically hurting alternatives of lockdowns and curfews?
  2. Do we need to tweak our capacity planning models for both the care providers and care establishments so that they are more liberal than efficient?
  3. Were the more efficiently produced medicines favored over the required ones leading to a crisis of required medicines in the market?
  4. Did the efficient just-in-time models for essentials like Oxygen contributed adversely to the situation?
  5. Are the efficient global supply chains leading to delayed development and deployment of vaccines, as the raw material is not even distributed; and so, it’s not easily available?
  6. Has an efficient opponent in form of the virus with adopted efficiency in medical ecosystem has led to a situation where efficiency kills?

The answers to these questions may give us permanent lessons in the need of building redundancy (and so helpful inefficiency) in the care ecosystem. A holistic evaluation is needed to mandate the right set of inefficiencies that we should allow in the care ecosystem. It’s a challenging task as inefficiency can prove extremely counterproductive if wrongly adopted, as we see in the state-run healthcare ecosystem.

Unfortunately, the cost for even this discussion is proving to be very high.

(Views expressed are personal).

#MONDAYMOTIVATION #Grow #BitbyBit #Bloom

I recently completed 200+ posts on this blog. This one is 208th. I wouldnt claim that I have been regular here but I always intended to be.

When I initially started this blog in 2017, I was planning to make it an ‘overnight success’. A thing that doesnt really exist. I started writing randomly but regularly on multiple topics. There was no theme, no rhythm and no pattern in them. But I kept writing.

Traffic was poor. It still is not that great though.

My topics ranged from general topics, common news, technology abstract to deep technology and so on. Again no specific theme but kept writing.

Then I decided to make ‘Monday Motivation’ as a regular feature here. I would say it went well for multiple weeks. Then it derailed as I couldnt see traffic coming as I had anticipated.

But still kept publishing. Monday Motivation posts became more regular and then few posts per week.

Finally, the pandemic gave a good push last year but incoherence in content led to a confused targeting and a mixed matrix.

I suspended regular blogging again to figure out how to manage this content initiative.

In April 2021, my entire family was hit by the pandemic. This led to a month long suspension of any kind of activity here. However, as soon as I could, I wrote the entire experience with a day wise log of our experience. This blog got more than 2000+ visitors so far and counting.

This gave me new ideas about how I want to manage the blog.

Now there are three parts to it –

  1. Monday Motivation will be regular. I promise to do it every week. Plan it better and do it better.
  2. Make this blog actually about growing daily only. Stories, ideas, theory, research and practical guide to grow will become a regular feature both in personal and professional domain.
  3. All tech related content and future tech content would move to http://www.atfortech.com. This site is work in progress and will soon be active.
  4. All financial and markets related blogging and content will go to http://www.wealthians.com. Its a dream of both my wife and mine to make this as our permanent long term career option. Fingers crossed.
  5. Adding more videos and relatable content to ensure that we have quick inputs on wide range of topics.

As you can see, its important to grow bit by bit but continuing to grow is uber essential.

Wish me luck as I embark this journey and also to yourselves so that you achieve everyday success.

#GrowDaily

#Covid Crisis: Two invisible factors

Coronavirus India News Highlights: PM Modi Urges EU Leaders To Support India,  South Africa On COVID
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The large population of India got into the clutches of the deadly Covid-19 virus with a ferocious and highly infectious second wave in March-April 2021.

My whole family was also impacted. Here is a day-by-day account of our experience.

A lot is being written about what governments did or did not, what experts said or did not, what people did or did not. However, what stands exposed is the vulnerability of 17% of human race to a black swan event in public health.

There is no denial that the severity and extent of the spread is largely attributed to the nature of the mutant B.1617 that has ravaged through the sub-tropical terrain of the country, hitting metropolitan centers first, and now making inroads in the hinterland.

The one thing that is clear is the amount of pressure and in some unfortunate cases, the collapse of the various parts of the medical value chain. Starting from the procurement of essential inputs for medicines, vaccinations and even oxygen, to the actual care center where the patient is being attended. There are multiple points of failure, which got amplified with the enormity of the problem. In nut shell, the patients and their families suffered, the care givers and their families suffered, the administrators suffered and all other critical players of the value chain suffered.

The significant number of cases and subsequent misery is really painful. However, as some dust starts to settle, at least in the metro centers, one can find some of the partially overlaying and seemingly unseen factors that have accentuated the pain.

In my amateurish research, I could isolate two factors that need serious review for a future readiness of any such unfortunate event –

  1. Reaction: Traditional administrative response due to colonial history led to seeking more control of the resources in hand than focusing on problem solving. Some parts were covered by Chief Economist of Vedanta in his article here in a related context.
  2. Response: Lack of consistent information distribution framework between different parts of the federal structure of the country in the face of the pandemic.

Reaction: Traditional administrative response

It’s a known fact that the countries that have had a significant colonial past, have an inherent administrative method of working, often proudly termed as legacy. The method relies on identifying the entity with maximum control over the available essential and required resources as the most powerful one. This is a typical command and control mechanism. Consequently, an intense tug of war ensues between different sections of the federal structure, all the way from the top to the lowest level in the hierarchy. In the current crisis, this tug of war, has proved counterproductive in many ways, as is clear from news reported from multiple quarters. Due to this never-ending siege to gain control, the core problem is often ignored or forgotten.

To paraphrase from the above-mentioned article, the complimenting complacency is so deep-rooted that one starts believing that they can practically control everything, even the pandemic. Only to be proven grossly wrong as witnessed with the unfortunate episode in India.

However, a problem-solving approach can turn the tables. When one compares India with all leading developing nations, this difference in response mechanism to a similar crisis is visible.

This could be the moment to demonstrate transformational leadership for national executive. If a problem-solving approach is taken from top to bottom, then there could be permanent change in state of affairs in the country. It is imperative that the leadership takes lessons from this crisis, to fully realize all the points of failure in the current medical care value chain and built a robust plan to upgrade it to become world class, or even better.

A key starting point for this is to significantly increase the union budget provisioning for healthcare care. The healthcare allocation was doubled in FY 2021. That was prior to the pandemic outbreak. We should now re-assess the allocation. From a paltry 2.5% at the moment (after the increase), it should be increased multi-fold to upgrade the entire ecosystem, as has been rightly called out by many experts including the Indian Medical Association. Technology upgrades, manpower training and induction including care providers and administrators, investing in R&D and building a denser network of well-equipped health care centers. These are some areas that can be of focus. Of course, experts can provide much more inputs to it.

An initiative like ‘Swasthya Bharat Abhiyan’ in line with ‘Swachch Bharat Abhiyan’ could be the need of the hour.

Response: Lack of CoNSISTENT INFORMATION DISTRIBUTION Framework

An unfortunate but clearly visible aspect of the outbreak management has been a failure of the collaborative communication between multiple entities. Professional compulsions aside, a lack of a comprehensive and reliable communication and information distribution has significantly contributed to this problem.

Take the example of foreign aid distribution, post its arrival in Delhi airport. A simple dashboard with details of inbound shipment and outbound shipment status, along with point of origin, destination, items in shipment, split of shipment, current status (even if updated manually once in a day) would have saved multiple stressful hours of internal and external bickering. The bandwidth thus saved could have been utilized in other places.

At state level too, inconsistency of a consistent information distribution framework for basics like hospital beds, medicine availability, plasma donors, oxygen supply availability etc. took the chaos to the streets. Even in the National Capital of Delhi, at one point there were multiple posts all over social media seeking help for their kith and kin. Multiple posts used to be posted within a minute. It was overwhelming. It still happens but the frequency is lesser.

Its commendable that multiple individuals and private players built different applications to address this to some extent. However, lack of bandwidth to keep the information updated rendered most of these apps useless.

Petty it may sound, but in all the joint CM and PM meetings, or in one-to-one CM meetings or in any meetings within their staffs, one common and consistent framework for information distribution, could have just reduced replication of same last mile pains in multiple parts of the country.

Moments of crisis like these lead to amplified distrust among the professional opponents. A transparent, technology-driven and easily accessible communication toolset could have led to reduction in replication of similar pain points, artificially generated due to the administrative inefficiencies.

There are many lessons to be learned from the current crisis but the topmost priority remains providing as much care as possible to the affected. As quickly as possible and to save as many human lives as possible.

Closing with a big shout out to all the care providers who are relentlessly working to make the world a better place to live.  

(All views are personal.)

#MONDAYMOTIVATION #BadThings lead to #BestThings

In 2008, I was working in the US. Comfortably placed, nice salary, driving a brand new SUV and enjoying the best time in youth that one can have.

I had celebrated the arrival of 2008 with a bang. Partied all night and then slept for majority of the day just to spend the evening to kill the hangover of the binge.

This was routine for most of the weekends that followed. Work for 5 days and then party for the weekend. I thought life cant be better.

I was living a dream and I had already planned how would I spend the rest of my life in the land of opportunities.

Then in middle of Feb 2008, I got a call from my mother. She said ‘ Get on the next flight to India immediately. Your father is hospitalised. Doctors are saying chances are 50-50.’

I took the next flight and spent the toughest 17 hours of my life at the time, unsure what news awaits me when I land in Delhi.

I landed in Delhi. Thankfully, my father was on the path of recovery and was discharged in a week’s time. Due to some visa stamping delay, I was able to spend another couple of weeks with my parents in our home. They had been living alone there as all three of us (me and my siblings) had pursue our lives in the US. I enjoyed the time a lot.

On my way back, I pondered over the sequence of events and complete helplessness my mother faced, when my father fell sick. She had practically no straight means to take him to the hospital. The more I thought, the more I cursed my staying away from my parents.

By the time I landed in New York, I was convinced that I have to return to India and be with my parents to take care of them. I finished my visa tenure and returned to India in Feb 2011. After couple of years of wandering in different cities in India, I finally moved back to Delhi in March 2014.

Seven years later, we got shipwrecked with Corona virus. With all of us diagnosed with the deadly virus infection, the thing that kept us going for over 2 weeks of painful ailment was our being together and united as a family.

I am convinced that returning to India is the best family-related decision of my life. Unfortunate and painful though but the strength of togetherness during Covid times showed me that there cannot be anything better than this strength.

It was during the bad times in 2008 that put me on path to the best times in our lives.

Take everything in your stride.

Shipwrecked with Corona: 17 days of struggle and recovery

DNA Explainer: What are the types of COVID-19 variants found in India?
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On April 13, 2021, my RT-PCR report indicated that, I have tested positive with COVID-19. The next day, my parents also came positive. 7 days later, my wife and 3 year old son also tested positive, not with an RT PCR test but with another methodology called TrueNat Test. 9 days later my brother, his wife and their young kids aged 5+ and 2+ years also tested positive in Hyderabad, 1500 Kilometers away.

We had been shipwrecked with the dreaded virus. Below is the day-by-day synopsis of what went in for 17 days of home isolation.

Day (-3): Initial symptoms of sinus infection, nasal irritation and some cough. Took home medication thinking its regular flu.

Day (-2): First chills came in night. Thought could be linked to the sinus infection. Took regular paracetamol and continued usual activities. When the fever persisted in the evening, isolated myself. Ate Maggi for dinner. It tasted different. It was bland. Sense of taste was lost.

Day (-1): Fever still persists. Diarrhea came as a new symptom. Though I had tested negative for Covid 6 times in the last one year, felt this time I have fallen prey. Went for testing. Continued in self-quarantine.

Day 0: Report came positive. Immediately asked rest of the family members to get tested. An ambulance came by itself to take me to an isolation centre. Pleasantly surprised but politely declined the offer as the symptoms were still mild. Decided to continue with home quarantine. Doctor prescribed antibiotics, vitamins, Zinc, paracetamol, some antacids, and lots of fluids. Medication started. Fever rose to 100-degree F. My wife called our friend, Dr. Ajay Dogra, who is a senior Director in Fortis. He asked to get into tele-consultation with a pulmonologist, Dr. Manoj Goel from Fortis Gurgaon. She could arrange an appointment only for next day.

Here is a very informative video on how to interpret CT score in your RT-PCR report.

Day 1: Fever rose to 101-degree F. Parents tested positive. Wife and son tested negative. (Some Relief). Split the house into two zones – containment area for myself and parents and regular for my wife and son. Oximeter and steam machine were arranged. Regular checks on oxygen levels started. Mother started feeling chills and reported first symptoms. Wishes from all the world for quick recovery started pouring in. Some shared very useful videos for breathing exercises. I assumed I wouldn’t need them so ignored them at the time. Consulted with the doctor, he didn’t look alarmed, though reading expressions was impossible as he was fully decked up in PPE kit, masks and other precautionary accouterments. He prescribed a couple of changes in medication.

Day 2: Fever persisted at 102-degree F. Dr. Dogra told to reduce air conditioning temperature as paracetamol does not work for 102-degree F levels of temperature. Got no respite. Wore a wet vest and slept. Fever reduced temporarily.

Day 3: Body ache started and I started losing sense of time. Going to the washroom for regular chores became a punishment. Weakness coupled with some breathlessness made these chores very difficult. My oxygen level started to dip to 95. I started to getting scared. Thoughts of going to ICU started coming to me. While sleeping, I dreamed of struggling alone in an ICU room. Fever persisted at 102-degree F. Parents started having continuous fever of 100-degree F. We were worried if we would need to take them to ICU, what would happen.

Day 4: One of the worst days in the whole period. Could not complete daily chores in one go. Had to come out midway and had to take a 30-minute break to continue. Felt the end is near. Some coughing happened. I could see blood in phlegm. Throughout the day, the body was high on fever ranging from 101-degree F to 102-degree F. Was worried about parents too as their temperature was around 100-degree F. My oxygen dropped to 93% SPO2 level. Got really worried. Immediately got into prone position. In one hour, pulled it back to 97%. Some respite. However, start hallucinating about horrific ICU wards in hospitals if I were to go there. In the night, decided to sleep in the prone position itself. Day long sleep made it difficult to catch up with sleep at night. At around 3 a.m., I woke up. Lot of blood laden mucous came out of from my nose. But I felt really good. Energized. Went back to sleep at 5 a.m. and woke up in 3 hrs.

Day 5: This was the day for second consultation with Doc. Morning problems did not subside. Fever came down one degree to range from 99-degree F to 100-degree F. Psychological pressure of the disease led to minor argument with wife on a trivial thing. Felt really bad afterwards. Mother’s oxygen pressure started dipping and came to 95%. Got her into prone position to pull it back to 97%. Doc’s consultation was quick and smooth. He asked to get an HRCT done and return. Gave some medication to provide relief from the morning breathlessness. Wife reported she is feeling sick and has fever. Son also had mild fever. Did we infect them now? Immediate remedy was to give them paracetamol to control the fever. It worked. Brother reported initial symptoms from Hyderabad, 1500 kms away.

Day 6: Good day finally. No fever today. Felt energized. Went for HRCT scan and found that there is moderate pneumonia in the lungs. Spent time researching the numbers. Day went by smoothly. Wife lost taste and smell. Son was fine. Next worry was to get them tested. Parent’s condition remained static with oxygen levels above 95% SPO2 and fever around 99-degree F. Father started getting frustrated with the situation but recovered soon remembering that he is head of the family and he has to stay course positively.

Here is how to read the HRCT scan report by Dr. K K Agarwal.

This is in Hindi and English but from a very reliable Doctor.

A very information video on HRCT score and CT Score

Day 7: Wife and son went for testing at a different facility. They were charged three times the regular for testing. I pretended that I am getting normal. Sensing that I may become casual, Dr. Dogra called and asked me to be very careful for the next 2-3 days. I arranged for the doctor’s consultation. Continued with resting. My taste started to improve a bit. First day when parents reported that their fever is not there. It came back in evening though. Mother reported problems in speaking as she felt something was obstructing her. Got their appointment as well with the Doctor. Brother confirmed positive test outcome for all including his two young kids aged 5+ years and 2+ years.

Day 8: Doc saw my report and didn’t sound alarmed. Relief. He put me on some steroids and changed dosage for other medication. He asked for series of blood tests and HRCT scan for both the parents. Wife and son’s report didn’t come as the hospital they went to didn’t provide an update. Started chasing them over phone. I continued to feel that I am improving though there was some pressure in breathing if I spoke for 10 minutes. With steroids, my body became like a food guzzler. I was always hungry from then on.

Day 9: Doc consultation for parents arranged. Heard wife was arguing with the testing facility help desk over reports. The lab in-charge promised she will arrange reports in 4 hrs. Both wife and son came positive. They used some new technique called ‘TrueNat’ instead of RT-PCR. We didn’t trust the result but still removed the barriers in the house. Now, everyone was infected so work load sharing could be done. Wife had been overburdened with work. I continued to feel better. Oxygen levels maintained above 95% for all. Mother’s voice was still a concern.

Day 10: Doc changed medication for parents and put them on steroids. Since both the parents are diabetic, had to chase their other doctors for co-morbid ailments for approval of medication. They recommended a sugar level test twice a day and remedial action in case of high sugar.

Day 11, 12, 13: Situation improved at home. Doc reviewed wife’s condition and recommended no medication other than for immunity and also to recover taste and smell. Parents also continued to improve. I felt better.

Day 14: Doorbell rang and a policeman was there. He had been sent by local District Magistrate to take care of us. Told him he is late by 2 weeks. He spoke to his boss and after multiple back and forth calls between me, him and his boss, he finally went away.

Day 15 : I resumed office. Energy levels were still down so first day was laborious. Situation improved everyday but its clear, it’s a long way to go.

Day 17: Doc reduced my steroids consumption to half of initial dosage. Hunger reduced. I complained of feeling like my mouth is always dry. Doc suggested to eat sugar free chewing gum to keep the mouth hydrated.

What worked for us?

  1. Timely testing when we started seeing initial symptoms.
  2. Researching before reacting. We got a lot of inputs from multiple places but we didnt immediately adopt anything without proper research. This is very crucial.
  3. Taking doctor’s prescription immediately instead of relying on local or home remedies.
  4. Ignore WHATSAPP recommendations completely.
  5. Just going by doctor’s advice instead of scrambling with a long list of tests and recommendations.
  6. Immense help from people around us. Our maid ensured we got home cooked food every day. Our driver checked in regularly despite the fact that he himself was positive with very mild symptoms. Our neighbours and extended family regularly checked in and provided food and supplies as required.
  7. Greetings, offers for help, flowers, regular checks and even messages from senior management of my employer kept the spirits really high.
  8. 3 liters of lemonade (sugar free) everyday
  9. Fresh juices from citric fruits like oranges etc.
  10. Sprouts, cottage cheese, eggs, protein, protein, protein…
  11. Regular checks on oxygen
  12. Steaming along with breathing exercises like anulom vilom. This is a great video for breathing exercises.
  1. Regular walks inside the house even if we got tired in 10 minutes.
  2. Staying positive
  3. Cracking jokes and having fun when the fever was gone
  4. Dividing household work amongst all of us so that there is no one person struggling alone.
  5. Prayers to God. Fact that we all were sick during the navraatri, we believe Goddess Durga was kind on us and helped us navigate through the worst phase of our life so far.

You can find a lot of informative and useful videos on this channel. Lot of people are struggling to interpret their blood reports, these videos help with that too.

Channel for Dr. K K Aggarwal.

Update: Dr. K K Aggarwal, who has been referred to multiple times in this post succumbed to Covid-19 on May 17, 2021. My deepest condolences with his family. He shall always remain with us with the work he has done over the years and esp. for education about Covid-19. Om Shanti!

These are very tough times for many in India. While we are thankful to God that we have closed in to recovery, we pray for an early rebound to normal times for everyone affected.